Method and implant for securing ligament replacement into the knee

ABSTRACT

A surgical method and implant for directing and securing a replacement ligament into the femur or tibia of the knee. A transverse tunnel may be formed in the femur approximately perpendicular to a femoral tunnel. A flexible strand passing through the transverse tunnel may be used to draw the replacement ligament into the femoral tunnel. The implant may then be placed into the transverse tunnel and through the replacement ligament to secure the replacement ligament in place. The implant may include an eyelet to receive the flexible strand and a tapered portion forming a shoulder to prevent the implant from being inserted too far into the transverse tunnel. The implant may also have a multi-angular configured portion to secure the implant within the transverse tunnel through an interference fit.

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application is a continuation of co-pending U.S. PatentApplication Ser. No. 09/942,111, filed Aug. 28, 2001, entitled “METHODAND IMPLANT FOR SECURING LIGAMENT REPLACEMENT INTO THE KNEE,” which ishereby incorporated by reference herein in its entirety, including butnot limited to those portions that specifically appear hereinafter,which application claims the benefit of U.S. Provisional Application No.60/228,357, filed Aug. 28, 2000, which is also hereby incorporated byreference herein in its entirety, including but not limited to thoseportions that specifically appear hereinafter.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

[0002] Not Applicable.

BACKGROUND OF THE INVENTION

[0003] 1. The Field of the Invention

[0004] The present invention relates to the placement and fixation of aknee ligament replacement in tunnels formed in a longitudinal directionthrough the tibia and femur bones. The method of the present inventionrelates more particularly, but not entirely, to a method of securing theligament replacement in a reliable manner that facilitates biologicalhealing of replacement material into the bone.

[0005] 2. Description of Related Art

[0006] When a ligament such as the anterior cruciate ligament(hereinafter “ACL”) or posterior cruciate ligament (hereinafter “PCL”)is torn or damaged, a replacement ligament may be used to reconstructthe natural ligament. A variety of biologic and synthetic materials havebeen developed for this purpose. In order to install the replacementligament, tunnels may be drilled in a longitudinal fashion into the“footprints” of the native ligament positions to replicate the functionof the natural ligament. Such techniques are well known and are incommon domain.

[0007] Various methods and devices have been devised for the purpose ofboth placing and securing a ligament replacement into bone depending onthe specific characteristics of the material. E. Marlowe Goble firstdevised a drill guide that would direct a drill point transversely to abone tunnel drilled longitudinally into a knee bone. See U.S. Pat. No.4,985,032. Thereafter, a means was devised for securing a soft ligamentreplacement into the femur by passing the tendons over a pin placedtransversely across the femoral tunnel. See U.S. Pat. Nos. 5,266,075 and5,393,302. Goble and Jerry L. Lower then designed a method and implantfor securing a bone plug in the tunnel. See U.S. Pat. Nos. 5,350,380 and5,397,356 and 5,562,671. Other inventors such as Thomas Rosenberg, seeU.S. Pat. No. 5,139,520, have used soft tissues and transverse devicesto secure ligament grafts into the femur. Replacement ligaments can alsobe secured with “interference” bone screws such as described by JeraldBowman et al., see U.S. Pat. No. 4,950,270, or a whole combination ofsutures tied to posts, staple type devices, and screw plates.

[0008] Ultimately, rounded cannulated implants were developed thatallowed for a soft ligament implant to be first captured by a wire, seeU.S. Pat. No. 5,918,604 (Jeffery Whelan), and brought in the tunnel ofthe femur and then secured by passing the cannulated implant along thepath of the wire, see U.S. Pat. No. 5,431,651 (E. Marlowe Goble), thussecuring the graft.

[0009] The prior art does not address certain challenges in the fielddiscussed above. The prior art is thus characterized by severaldisadvantages that are addressed by the present invention. The presentinvention minimizes, and in some aspects eliminates, certaindisadvantages and problems, by utilizing the methods and structuralfeatures described herein.

BRIEF SUMMARY OF THE INVENTION

[0010] The invention includes a surgical method and implant fordirecting and securing a replacement ligament into the femur or tibia ofthe knee. Utilizing bone tunnels in the femur and tibia, a step drillmay be directed through a cannulated drill guide located in the femoraltunnel to the opposite cortex. A flexible strand may be brought into thefemoral tunnel through the joint and retrieved from the transversetunnel, the flexible strand forming a loop external to the joint. Oneend of the flexible strand may be directed through a medial transverseopening of the transverse tunnel and the other through a lateraltransverse opening. Tensioning of the flexible strand causes thereplacement ligament material to be drawn into the femoral tunnel. Anovel implant described herein may then be passed into the transversetunnel, passing through the ligament replacement and securing theligament replacement within the femoral tunnel. A reverse method may beutilized to secure the tibial end of the ligament replacement.

[0011] The implant may include an eyelet to receive the flexible strandand a tapered portion forming a shoulder to prevent the implant frombeing inserted too far into the transverse tunnel. The implant may alsohave a multi-angular configured portion to secure the implant within thetransverse tunnel through an interference fit.

[0012] Additional advantages of the invention will be set forth in thedescription which follows, and in part will be apparent from thedescription, or may be learned by the practice of the invention withoutundue experimentation. The advantages of the invention may be realizedand obtained by means of the instruments and combinations particularlypointed out in the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

[0013] Certain features and advantages of the invention will becomeapparent from a consideration of the subsequent detailed descriptionpresented in connection with the accompanying drawings in which:

[0014]FIG. 1A is a perspective view of an implant in accordance with theprinciples of the present invention;

[0015]FIG. 1B is an end view of the implant of FIG. 1A, with radialreference lines;

[0016]FIG. 2A is a top view of the implant of FIG. 1 as it passesthrough a cross section of a femoral tunnel;

[0017]FIG. 2B is a top view of the implant of FIG. 1 as it passesthrough a cross section of a femoral tunnel, the implant being shown ina position inserted further than the position shown in FIG. 2A;

[0018]FIG. 2C is a top view of the implant of FIG. 1 as it passesthrough a cross section of a femoral tunnel, the implant being shown ina position inserted further than the position shown in FIG. 2B;

[0019]FIG. 2D is a top view of the implant of FIG. 1 as it passesthrough a cross section of a femoral tunnel, the implant being shown ina position inserted further than the position shown in FIG. 2C;

[0020]FIG. 3A is a diagrammatical view of a femur and a tibia toillustrate flexible strands bringing up soft tissue grafts into thefemur;

[0021]FIG. 3B is a diagrammatical view of a femur and a tibia as in FIG.3A showing the soft tissue grafts drawn further into the femur;

[0022]FIG. 4A is a diagrammatical view of a femur and a tibia as in FIG.3A showing a passing pin driven through the femur to position theimplant of FIG. 1;

[0023]FIG. 4B is a diagrammatical view of a femur and a tibia as in FIG.4A showing the implant of FIG. 1 entering the transverse tunnel;

[0024]FIG. 5A is a diagrammatical view of a femur and a tibia toillustrate the implant of FIG. 1 being placed in a fully recessedposition by an impactor with a projecting tip;

[0025]FIG. 5B is a diagrammatical view of a femur and a tibia toillustrate the implant of FIG. 1 placed in a fully recessed position;

[0026]FIGS. 6A and 6B are two different configured drill tips which maybe used in accordance with the methods of the present invention;

[0027]FIG. 6C is a side view of a cannulated drill guide;

[0028]FIG. 7A is a diagrammatical view of a femur and a tibia toillustrate use of the cannulated drill guide during drilling of thefemur;

[0029]FIG. 7B is a diagrammatical view of a femur and a tibia as shownin FIG. 7A showing the drill extending through the femur;

[0030]FIG. 8A is a diagrammatical view of a femur and a tibia toillustrate the principles of the present invention may be used indrilling from the medial to the lateral direction (inside of the knee tothe outside), which is opposite to the directions as shown in the otherfigures; and

[0031]FIG. 8B is a diagrammatical view of a femur and a tibia asillustrated in FIG. 8A, showing the implant of the present inventionembedded in the transverse tunnel.

DETAILED DESCRIPTION OF THE INVENTION

[0032] For the purposes of promoting an understanding of the principlesin accordance with the invention, reference will now be made to theembodiments illustrated in the drawings and specific language will beused to describe the same. It will nevertheless be understood that nolimitation of the scope of the invention is thereby intended. Anyalterations and further modifications of the inventive featuresillustrated herein, and any additional applications of the principles ofthe invention as illustrated herein, which would normally occur to oneskilled in the relevant art and having possession of this disclosure,are to be considered within the scope of the invention claimed.

[0033] Before the present components and methods are disclosed anddescribed, it is to be understood that this invention is not limited tothe particular configurations, process steps, and materials disclosedherein as such configurations, process steps, and materials may varysomewhat. It is also to be understood that the terminology employedherein is used for the purpose of describing particular embodiments onlyand is not intended to be limiting since the scope of the presentinvention will be limited only by the appended claims and equivalentsthereof.

[0034] The publications and other reference materials referred to hereinto describe the background of the invention and to provide additionaldetail regarding its practice are hereby incorporated by referenceherein. The references discussed herein are provided solely for theirdisclosure prior to the filing date of the present application. Nothingherein is to be construed as a suggestion or admission that theinventors are not entitled to antedate such disclosure by virtue ofprior invention.

[0035] It must be noted that, as used in this specification and theappended claims, the singular forms “a,” “an,” and “the” include pluralreferents unless the context clearly dictates otherwise.

[0036] In describing and claiming the present invention, the followingterminology will be used in accordance with the definitions set outbelow.

[0037] As used herein, “comprising,” “including,” “containing,”“characterized by,” and grammatical equivalents thereof are inclusive oropen-ended terms that do not exclude additional, unrecited elements ormethod steps.

[0038] As used herein, “consisting essentially of” and grammaticalequivalents thereof limit the scope of a claim to the specifiedmaterials or steps and those that do not materially affect the basic andnovel characteristic or characteristics of the claimed invention.

[0039] The method of the present invention allows for the successfulplacement of a transversely placed implant into the femur to secure aflexible ligament graft used in the reconstruction of the anteriorcruciate ligament.

[0040] The novel implant and method of graft fixation of the presentinvention provides multiple advantages over the previous methods andimplants described above. The current implant may be of a solid formwith a distal portion and a body portion attached to a multi-angular endportion. The distal portion may include an eyelet for the placement of asuture or other flexible material used in directing the implant aroundthe replacement ligament. The implant may be secured into bone byimpacting the multi-angular end, that has a slightly larger externaldimension than the transverse round hole into the corresponding bone,and making it flush with external bone cortex. The compressive forcesinherent to the geometrical mis-match between the implant and thetransverse tunnel, secure the implant in place. The geometry of thepresent implant allows for a smaller profile and leads to theapplicability of materials not heretofore utilized in transverseligament fixation.

[0041] Certain aspects of the invention will be set forth in thedescription which follows, and in part will be apparent from thedescription, or may be learned by the practice of the invention withoutundue experimentation. The features and advantages of the invention maybe realized and obtained by means of the instruments and combinationsparticularly pointed out in the appended claims.

[0042] Referring now to FIG. 1, a perspective view is shown of animplant, generally indicated at 12, in accordance with the principles ofthe present invention. The implant 12 preferably includes a proximal end14, a distal end 16 and defines a longitudinal axis 18. The implant 12may be constructed of any suitable material such as metal, polymer, orbone that is preferably inert or biologically compatible. The implant 12is preferably substantially solid, characterized by the absence of acannulation along the longitudinal axis 18.

[0043] The implant 12 may include a multi-angular portion 20 at theproximal end 14. The multi-angular portion 20 preferably has a polygonalcross section which may form a square for example. It will beappreciated that the multi-angular portion 20 may be formed of variousdifferent polygonal shapes, such as triangular, pentagonal, hexagonal,etc., within the scope of the present invention. The multi-angularportion 20 preferably forms a plurality of ridges 22 which extendsubstantially parallel to the longitudinal axis 18. The multi-angularportion 20 is preferably configured to have a slightly larger crosssection than a hole in the bone receiving the implant 12 such that aninterference fit is formed between the bone and the ridges 22 to holdthe implant 12 in place. An interference fit as used herein refers to anabutting contact between two objects to prevent the two objects frommoving with respect to each other in a particular direction.

[0044] The multi-angular portion 20 may also include a fitting 32 on theproximal end 14 for receiving a driver 54 (see FIG. 5A) to drive theimplant 12 into the bone. The fitting 32 may be formed as a recess thatis configured to receive a projecting tip 56 of the driver 54 tomaintain contact between the driver 54 and the implant 12 while theimplant 12 is being driven into the bone.

[0045] In an alternative embodiment of the implant 12, the multi-angularportion 20 may be replaced with a threaded portion (not shown). Thethreaded portion may have a cylindrical configuration with threads onthe exterior surface to grip the receptor bone for fixing the implant 12in place.

[0046] The implant 12 may also include a body portion 24 adjoining themulti-angular portion 20. The body portion 24 may have a cylindricalconfiguration which may have a slightly smaller radial dimension thanthe multi-angular portion 20 such that the ridges 22 extend radiallybeyond the body portion 24, as is clearly shown in FIG. 1B. The bodyportion 24 is preferably configured to facilitate insertion of theimplant 12 within a bone. Thus, the surface of the body portion 24 ispreferably substantially smooth, without threads or ridges for example.

[0047] In one embodiment of the present invention shown in FIG. 1B, aradial dimension 21 of the body portion 24 is substantially equal to aradial dimension of the multi-angular portion 20 at a point 23 betweenthe ridges 22, whereas a radial dimension 25 of the multi-angularportion 20 at the ridges 22 is larger than the radial dimension 21 ofthe body portion 24. This relationship of sizes helps the insertion ofthe implant 12, since a smooth transition exists between the bodyportion 24 and the multi-angular portion 20 at the point 23 between theridges 22. Furthermore, the larger radial dimension 25 of the ridges 22provides an interference fit between the ridges 22 and the receptor bonewhen the implant 12 is installed. It will be appreciated however, thatother radial dimensions may be used within the scope of the presentinvention.

[0048] Adjoining the body portion 24 is preferably a tapered portion 26.The tapered portion 26 preferably has a taper such that the crosssectional area of the tapered portion 26 reduces from the body portion24 toward a distal portion 28 at the distal end 16 of the implant 12.The amount of taper of the tapered portion 24 is preferably sufficientto form a shoulder between the body portion 24 and the distal portion 28to prevent the implant 12 from being inserted too far into the bone asdiscussed more fully below.

[0049] The distal portion 28 may have a substantially cylindrical shapedconfiguration, or may have a conical configuration with a taperedexterior surface to facilitate insertion of the implant 12 into thebone. An eyelet or opening 30 is preferably formed in the distal portion28, in a direction transverse to the longitudinal axis 18 for receivinga flexible strand or suture.

[0050] The importance of the geometric configuration of the implant 12is illustrated in FIGS. 2A-2D, which show top views of the implant 12 asit progressively passes through a cross section of a femoral tunnel 34(a description of the femoral tunnel is provided in greater detailbelow). As shown in FIGS. 2A-2D, the implant 12 is inserted transverseto the femoral tunnel 34 to attach replacement ligaments or soft tissuegrafts 36 within the femoral tunnel 34. The replacement ligaments orsoft tissue grafts 36 may be formed of any variety of biologic andsynthetic materials known to those skilled in the art of reconstructingdamaged natural ligaments. As shown in FIG. 2A, the conical distalportion 28 facilitates insertion of the implant 12 through the femoraltunnel 34. As the implant 12 is inserted further within the femoraltunnel 34, as shown in FIG. 2B, the taper of the distal portion 28causes the soft tissue grafts 36 to be compressed against a sidewall ofthe femoral tunnel 34. As shown in FIG. 2C, further compression of thesoft tissue grafts 36 occurs as the tapered portion 26 and body portion24 are inserted into the femoral tunnel 34. When the implant 12 is fullyinserted within the femoral tunnel 34, as shown in FIG. 2D, the largerdiameter of the body portion compresses the soft tissue grafts 36 inplace against a sidewall of the femoral tunnel 34, and the taperedportion 26 forms a shoulder which abuts against an annular seat 46 inthe receptor bone, as shown in FIGS. 3-5, to prevent the implant 12 frombeing inserted too far into the receptor bone.

[0051] The implant 12 is preferably configured to have a rate of taperfrom the proximal end 14 to the distal end 16. The rate of taper isdefined as the change in radial distance from the center of the implant12 to the exterior surface of the implant, per unit distance along thelongitudinal axis 18. For example, the body portion 24 preferably has auniform cylindrical cross section and therefore has no taper, whereasthe tapered portion 26 has a larger rate of taper than the body portion24 or the distal portion 28. The higher rate of taper of the taperedportion 26 forms a shoulder that is positioned a predetermined distancefrom a proximal most end of the body portion 24 to thereby engage incontact against the annular seat 46 formed within the femur 38 andthereby limit an insertion depth of the implant 12.

[0052] The implant 12 is preferably configured and dimensioned such thatthe distal portion 28 and body portion 24 are long enough to extendacross the femoral tunnel 34 to facilitate insertion of the implant 12and provide uniform support of the soft tissue grafts 36. Whereas thetapered portion 26 is configured to be relatively short in comparisonwith the distal portion 28 and the body portion 24 to form a shoulderbetween the distal portion 28 and the body portion 24. The shoulderformed by the relatively short tapered portion 26 allows for morecontrol over the fully inserted position of the implant 12. Similarly,the length of the multi-angular portion 20 is configured to provideadequate support to secure the implant 12 within the transverse tunnel48.

[0053] The method of securing ligament replacement into the knee usingthe implant 12 will be further described by reference to FIGS. 3A-3B,which show diagrammatical views of a femur 38 and a tibia 40 withportions broken away to illustrate flexible strands 42 bringing up softtissue grafts 36 into the femur 38. Flexible strands 42 may include anyvariety of surgical filaments known to those skilled in the art. Alongitudinal tunnel 44 is formed in the tibia 40 and femur 38 in amanner known to those skilled in the art. The longitudinal tunnel 44extends into the femur to form the femoral tunnel 34. Also, a transversetunnel 48 is formed in the femur 38, in a manner described more fullybelow. Preferably, the transverse tunnel 48 has a smaller diameter thanthe femoral tunnel 34, and the transverse tunnel 48 penetrates thefemoral tunnel 34 at an approximate right angle.

[0054] As shown in FIG. 3A, flexible strands 42 are preferably loopedaround soft tissue grafts 36 in preparation for ACL reconstruction ofthe knee. Two flexible strands 42, and two soft tissue grafts 36 areshown in FIG. 3A, however, it will be appreciated that other quantitiesof strands 42 and soft tissue grafts 36 may be used within the scope ofthe present invention. The flexible strands 42 are preferably placedretrograde into the femoral tunnel 34 and grasped by an instrument 50through the transverse tunnel 48 to then be brought outside of the femur38. Instrument 50 may be any suitable tool known in the art, such asgrasping forceps, or a snap on attachment to an arthroscope for example.As shown in FIG. 3B, the soft tissue grafts 36 may be pulled into thefemoral tunnel 34 and the flexible strands 42 may exit the femur 38through the transverse tunnel 48. It will be appreciated that the methoddescribed above may be used to position the soft tissue graft 36 in thelongitudinal tunnel 44 for securing the soft tissue grafts 36 usingstaples, implants or any other manner known in the art, within the scopeof the present invention.

[0055] Referring now to FIG. 4A, a pair of the flexible strands 42 maybe place through the eyelet 30 of the implant 12 and tied into a knot.The other pair of the flexible strands 42 may be passed through an eyeof a passing pin or “Beath” pin 52. The passing pin 52 may be driventhrough the transverse tunnel 48 and out the opposite side of the femur38. As shown in FIG. 4B, as the flexible strands 42 are pulled away fromthe implant 12 causing tensioning of the flexible strands 42, the softtissue grafts 36 may be brought further up into the femoral tunnel 34,and the implant 12 may be pulled into the transverse tunnel 48. Theimplant 12 may be pulled underneath the soft tissue grafts 36 until thetapered portion 26 makes contact with the annular seat 46 in the femur38 surrounding the transverse tunnel 48.

[0056] As shown in FIG. 5A, a driver or impactor 54 having a projectingtip 56 may be used to seat the implant 12 within the transverse tunnel48. The projecting tip 56 may be inserted into the fitting 32, as shownmost clearly in FIG. 1, to maintain contact between the driver 54 andthe implant 12. The driver 54 may be used to force the implant 12 intothe transverse tunnel 48 until the implant 12 is fully inserted to thepoint where the tapered portion 26 contacts the annular seat 46, andwhere the implant is in a recessed position within the femur 38, asshown in FIG. 5B. It will be appreciated that the driver 54 may be anysuitable tool known to those skilled in the art for forcing the implant12 into the transverse tunnel 48.

[0057] Referring now to FIGS. 6A, 6B, and 6C, a side view is shown of acannulated drill guide 58 and two different embodiments of drill tips,generally indicated at 60, which may be used to form the transversetunnel 48 in accordance with the principles of the present invention.The drill guide 58 includes an aperture 62 for receiving the drill tip60 to allow the transverse tunnel 48 to be positioned properly withrespect to the femoral tunnel 34. The aperture 62 preferably has afunnel shape to direct the drill tips 60 into the center of the passage70. The drill tips 60 preferably include a small diameter portion 64 anda larger diameter portion 66 separated by an abutment portion 68. Thesmall diameter portion 64 may be used to drill a portion of thetransverse tunnel 48 for receiving the passing pin 52, whereas thelarger diameter portion 66 may be used for drilling a portion of thetransverse tunnel 48 for receiving the implant 12. The two differentdiameters of the drill tip 60 allow for different sized portions of thetransverse tunnel 48 to be drilled in a single step.

[0058] As shown in FIGS. 7A-7B, the drill guide 58 may be inserted intothe longitudinal tunnel 44 and attached to an external drill arm andguide 72. The two step drill 60 may be placed in a guide barrel 74 toensure that the transverse tunnel 48 is positioned properly. As thedrill 60 moves into the femur 38 the funnel shaped aperture 62 guidesthe drill 60 through the passage 70 until the abutment 68 contacts thedrill guide 58 as shown in FIG. 7B. At this point the drill 60 isprevented from extending further into the femur 38 and proper drillingof the transverse tunnel 48 is achieved.

[0059] As shown in FIGS. 8A-8B, the principles of the present inventionmay be used in drilling from the medial side 76 of the femur 38 to thelateral side 78 of the femur 38 (inside of the knee to the outside),which is opposite to the directions as shown in the preceding figures.Therefore, the implant 12 may be installed on the opposite side of theknee as previously discussed.

[0060] In the illustrated embodiment of the implant 12, thesmaller-dimensioned distal portion 28 facilitates the crossing of theimplant 12 across the lumen of the longitudinal tunnel 44, directed witha suture “leash,” minimizing interaction of the implant 12 with thereplacement ligament 36 until the distal portion 28 has reached thesmaller diameter portion of the transverse tunnel 48 on the oppositeside of the longitudinal tunnel 44. The larger-dimensioned, cylindricalbody portion 24 serves to secure the replacement ligament 36 either bycompressing it against the tunnel walls (in the case of a loopedmaterial), or by blocking the egress of the replacement ligament (in thecase of an attached block of bone). The utility of such an implant canbe seen by being applicable for use in either the femur 38 or the tibia40 and with replacement ligaments made out of soft tissue, bone blockattached, or synthetic material.

[0061] The method of insertion of this implant is not contemplated byprevious methods due to the lack of cannulation in the present implant.The process of developing a transverse tunnel 48 which intersects theprecise center of the longitudinal bone tunnel 44 is made possible bythe novel cannulated guide 58 and stepped drill 60. The guide 58 isfirst placed into the longitudinal bone tunnel 44 with the funnel shapedaperture 62 of the transverse cannulation or passage 70 directed towardsthe transverse drill guide 72 that is aimed at a perpendicular, directlyto the center of the longitudinal tunnel 44. A drill tip 60 with aninitial smaller diameter portion 64 capable of passing through thetransverse cannulation 70 of the guide 58 within the longitudinal tunnel44, and with sufficient length to broach the opposing cortex of bonecombined with the larger diameter portion 66 forming the abutment 68that stops the progress of the drill once reaching the longitudinaltunnel 44 is used to construct a transverse tunnel 48 of two differentbore dimensions with a single pass. The drill tip 60 and cannulatedguide 58 are then removed from the bone.

[0062] In the illustrated embodiment, the graft 36 may then be broughtinto the longitudinal tunnel 44 by first looping the graft 36 with aflexible strand 42 and then passing the flexible strand 42 into thelongitudinal tunnel 44 in a retrograde fashion. The flexible strand 42may then be brought out the medial and lateral aspects of the bone usingthe passing pin 52. The flexible strand 42 may be tensioned by pullingopposing portions of the strand 42 in substantially opposite directionswherein the graft 36 is brought up into the longitudinal tunnel 44 untilit sits just above the flexible strand 42 which is now straight in linewith the course of the previously constructed transverse tunnel 48. Oneend of the flexible strand 42 may then be attached to the implant 12 andwith or without the use of an impaction instrument 54, the implant 12may be brought into and across the longitudinal bone tunnel 44 thussecuring the replacement ligament 36. The implant 12 may be eitherdriven flush with the external cortex or cut flush with an appropriatecutting device.

[0063] This method and implant can be utilized in either the femur 38 orthe tibia 40 and with a variety of replacement ligament types unlikeother systems which have been constrained to specific grafts.

[0064] It will be appreciated that the structure, apparatus, and methodsdisclosed herein are merely examples of means for directing and securinga placement ligament into the femur or tibia of the knee, and it shouldbe appreciated that any structure, apparatus or system that performfunctions the same as, or equivalent to, those disclosed herein areintended to fall within the scope of a means for directing and securinga placement ligament into the femur or tibia of the knee, includingthose structures, apparatus or systems that are presently known, orwhich may become available in the future. Anything which functions thesame as, or equivalently to, a means for directing and securing aplacement ligament into the femur or tibia of the knee falls within thescope of this element.

[0065] In accordance with the features and combinations described above,a preferred method for fixing a replacement ligament within a firsttunnel of a bone includes the steps of:

[0066] (a) forming a second tunnel in said bone intersecting said firsttunnel;

[0067] (b) joining said replacement ligament to a strand and insertingsaid strand into said first tunnel;

[0068] (c) accessing said strand from said second tunnel and pullingsaid stand through said second tunnel to thereby position saidreplacement ligament into said first tunnel; and

[0069] (d) securing the replacement ligament in place within said firsttunnel.

[0070] It is to be understood that the above-described arrangements areonly illustrative of the application of the principles of the presentinvention. Numerous modifications and alternative arrangements may bedevised by those skilled in the art without departing from the spiritand scope of the present invention and the appended claims are intendedto cover such modifications and arrangements. Thus, while the presentinvention has been shown in the drawings and fully described above withparticularity and detail in connection with what is presently deemed tobe the most practical and preferred embodiment(s) of the invention, itwill be apparent to those of ordinary skill in the art that numerousmodifications, including, but not limited to, variations in size,materials, shape, form, function and manner of operation, assembly anduse may be made without departing from the principles and concepts setforth herein.

What is claimed is:
 1. An implant for securing and positioning a replacement ligament in a bone tunnel of a receptor bone, said implant comprising: a proximal end, a distal end and a longitudinal axis, wherein a cross sectional dimension of said implant at said proximal end is greater than a cross sectional dimension of said implant at said distal end; said implant having an opening at said distal end extending through said implant in a direction transverse to said longitudinal axis; wherein said implant is configured to receive a strand in said opening to position said replacement ligament against said implant for securing said replacement ligament in said bone tunnel.
 2. The implant of claim 1, further comprising a multi-angular portion at said proximal end, said multi-angular portion having a polygonal cross section configured to be inserted within said bone tunnel.
 3. The implant of claim 2, wherein said multi-angular portion has a fitting disposed thereon for attaching a driving member.
 4. The implant of claim 2, wherein said multi-angular portion forms a plurality of ridges extending substantially parallel to said longitudinal axis.
 5. The implant of claim 2, wherein said polygonal cross section is substantially square.
 6. The implant of claim 1, further comprising a body portion having a substantially uniform cross section.
 7. The implant of claim 6, wherein said body portion is substantially cylindrical.
 8. The implant of claim 1, further comprising a tapered portion which tapers to form a shoulder on said implant between said proximal end and said distal end.
 9. The implant of claim 1, further comprising a distal portion extending along said longitudinal axis at said distal end of said implant.
 10. The implant of claim 9, wherein said distal portion has a tapered configuration which reduces in cross-sectional area toward said distal end.
 11. The implant of claim 2, further comprising a body portion having a substantially cylindrical configuration adjoining said multi-angular portion.
 12. The implant of claim 11, further comprising a tapered portion adjoining said body portion, said tapered portion tapering to form a shoulder.
 13. The implant of claim 12, further comprising a distal portion adjoining said tapered portion at said distal end of said implant, said distal portion having a tapered configuration which reduces in cross-sectional area toward said distal end of said implant.
 14. The implant of claim 13, wherein said tapered portion has a length that is less than one fourth a length of said distal portion.
 15. The implant of claim 1, wherein said implant is made of metal.
 16. The implant of claim 1, wherein said implant is made of a polymer.
 17. The implant of claim 1, wherein said implant is made of a bone material.
 18. An implant for securing and positioning a replacement ligament in a bone tunnel of a receptor bone, said implant comprising: a multi-angular portion formed at a proximal end of said implant, said multi-angular portion having a polygonal cross section; a body portion adjoining said multi-angular portion, said body portion having a uniform cross section; a tapered portion adjoining said body portion, said tapered portion tapering in a proximal to distal direction to a smaller cross-sectional area away from said body portion; and a distal portion adjoining said tapered portion and extending to a distal end of said implant.
 19. The implant of claim 18, wherein said multi-angular portion has a fitting disposed thereon for attaching a driving member.
 20. The implant of claim 18, wherein said multi-angular portion forms a plurality of ridges extending substantially parallel to a longitudinal axis of said implant.
 21. The implant of claim 18, wherein said polygonal cross section is substantially square.
 22. The implant of claim 18, wherein said body portion is substantially cylindrical having a substantially smooth exterior surface characterized by an absence of helical threads.
 23. The implant of claim 18, wherein said distal portion has a tapered configuration.
 24. The implant of claim 18, wherein said tapered portion has a length that is less than one fourth a length of said distal portion.
 25. The implant of claim 18, further comprising an opening in said distal portion.
 26. The implant of claim 25, wherein said opening extends through said distal portion in a direction transverse to a longitudinal axis of said implant.
 27. The implant of claim 18, wherein said implant is substantially solid, characterized by an absence of a cannulation along a longitudinal axis of said implant.
 28. The implant of claim 20, wherein said multi-angular portion has a radial dimension at said ridges that is greater than a radial dimension of said body portion.
 29. The implant of claim 18, wherein said multi-angular portion has a substantially square cross section, wherein said body portion is substantially cylindrical, and wherein said distal portion has a tapered configuration.
 30. The implant of claim 18, wherein said implant is made of metal.
 31. The implant of claim 18, wherein said implant is made of a polymer.
 32. The implant of claim 18, wherein said implant is made of a bone material.
 33. An implant for securing and positioning a replacement ligament in a bone tunnel of a receptor bone, said implant comprising: a body portion, a distal portion, and a tapered portion residing between said body portion and said distal portion, said tapered portion having a taper such that a cross section of said tapered portion reduces in area from said body portion toward said distal portion, the implant having a rate of taper that is greater at said tapered portion than at said body portion and said distal portion such that the tapered portion forms a shoulder between the body portion and the distal portion; wherein said shoulder is configured and positioned a predetermined distance from a proximal-most end of the body portion to thereby engage in contact against an annular seat formed within said receptor bone, to thereby limit an insertion depth of the implant within said receptor bone.
 34. The implant of claim 33, further comprising a multi-angular portion at a proximal end of said implant, said multi-angular portion having a polygonal cross section configured to be inserted within said receptor bone to fix said implant within said receptor bone with an interference fit.
 35. The implant of claim 34, wherein said multi-angular portion has a fitting disposed thereon for attaching a driving member.
 36. The implant of claim 34, wherein said multi-angular portion forms a plurality of ridges extending substantially parallel to a longitudinal axis of said implant.
 37. The implant of claim 34, wherein said polygonal cross section is substantially square.
 38. The implant of claim 33, wherein said body portion is substantially cylindrical.
 39. The implant of claim 33, wherein said tapered portion has a length that is less than one fourth a length of said distal portion.
 40. The implant of claim 33, wherein said implant is substantially solid characterized by an absence of a cannulation along a longitudinal axis of said implant.
 41. The implant of claim 33, further comprising an opening in said distal portion.
 42. The implant of claim 41, wherein said opening extends through said distal portion in a direction transverse to a longitudinal axis of said implant.
 43. The implant of claim 33, wherein said body portion has a substantially smooth surface characterized by an absence of threads.
 44. The implant of claim 33, wherein said implant is made of metal.
 45. The implant of claim 33, wherein said implant is made of a polymer.
 46. The implant of claim 33, wherein said implant is made of a bone material.
 47. An implant for securing and positioning a replacement ligament in a bone tunnel of a receptor bone, said implant comprising: a multi-angular portion comprising a first end and a second end, said multi-angular portion having a polygonal cross section forming a plurality of longitudinal ridges extending between said first end and said second end; and a cylindrical body portion adjoining said second end of said multi-angular portion; wherein a radial dimension of said multi-angular portion at a point between said ridges is substantially the same as a radial dimension of said body portion to facilitate insertion of said multi-angular portion within said receptor bone.
 48. The implant of claim 47, wherein a radial dimension of said multi-angular portion at said ridges is greater than said radial dimension of said body portion to allow said multi-angular portion to form an interference fit between said implant and said receptor bone.
 49. The implant of claim 47, wherein said multi-angular portion has a fitting disposed thereon for attaching a driving member.
 50. The implant of claim 47, wherein said polygonal cross section is substantially square.
 51. The implant of claim 47, further comprising a tapered portion adjoining said body portion and a distal portion adjoining said tapered portion, said tapered portion forming a shoulder between said body portion and said distal portion.
 52. The implant of claim 51, wherein said distal portion has a tapered configuration such that a cross sectional area of said tapered portion reduces in a direction away from said body portion.
 53. The implant of claim 52, wherein said distal portion has an opening extending through said distal portion in a direction transverse to a longitudinal axis of said implant.
 54. The implant of claim 47, wherein said body portion has a substantially smooth surface, characterized by an absence of threads, and wherein said body portion is solid characterized by an absence of openings therein.
 55. The implant of claim 47, wherein said implant is made of metal.
 56. The implant of claim 47, wherein said implant is made of a polymer.
 57. The implant of claim 47, wherein said implant is made of a bone material.
 58. The implant of claim 47, wherein a substantially smooth interface is formed between said multi-angular portion and said body portion at said point between said ridges.
 59. A method for fixing a replacement ligament within a first tunnel of a bone, the method comprising the steps of: (a) forming a second tunnel in said bone intersecting said first tunnel; (b) joining said replacement ligament to a strand and inserting said strand into said first tunnel; (c) accessing said strand from said second tunnel and pulling said stand through said second tunnel to thereby position said replacement ligament into said first tunnel; and (d) securing the replacement ligament in place within said first tunnel.
 60. The method of claim 59, wherein the step of forming a second tunnel in said bone intersecting said first tunnel further comprises the step of inserting a cannulated drill guide in said first tunnel.
 61. The method of claim 60, further comprising drilling said second tunnel in said receptor bone using a drill having two different sized diameters including a smaller diameter forward portion and a larger diameter rear portion.
 62. The method of claim 61, further comprising passing said forward portion of said drill through said drill guide.
 63. The method of claim 62, further comprising passing said drill through said cannulated drill guide to a point where the larger diameter rear portion of the drill abuts with the cannulated drill guide.
 64. The method of claim 63, further comprising removing the cannulated drill guide from the first tunnel.
 65. The method of claim 59, wherein the step of joining said replacement ligament to said strand comprises wrapping said strand around said replacement ligament.
 66. The method of claim 59, wherein the step of grasping said strand through said second tunnel comprises inserting a tool in said second tunnel.
 67. The method of claim 59, further comprising connecting an end of the strand to a passing pin and passing said passing pin through said second tunnel such that said strand extends through said second tunnel.
 68. The method of claim 67, further comprising tensioning said strand to draw said replacement ligament into said first tunnel.
 69. The method of claim 67, further comprising attaching said strand to an opening in a distal end of said implant.
 70. The method of claim 69, further comprising pulling the implant into said second tunnel with said strand.
 71. The method of claim 70, further comprising driving said implant into a seated position in said second tunnel using a driver on a proximal end of said implant.
 72. The method of claim 59, further comprising compressing said replacement ligament against a sidewall of said first tunnel with said implant to hold said replacement ligament in place.
 73. The method of claim 59, wherein accessing said strand comprises grasping said strand.
 74. The method of claim 59, wherein securing the replacement ligament further comprises positioning an implant in said second tunnel.
 75. An implant for securing and positioning a replacement ligament in a bone tunnel of a receptor bone, said implant comprising: a proximal end, a distal end and a longitudinal axis, wherein a cross sectional dimension of said implant at said proximal end is greater than a cross sectional dimension of said implant at said distal end; a multi-angular portion at said proximal end, said multi-angular portion having a polygonal cross section configured to be inserted within said bone tunnel, said polygonal cross section forming a plurality of ridges extending substantially parallel to said longitudinal axis; a body portion adjoining said multi-angular portion, said body portion having a substantially uniform cross section, wherein said body portion is substantially cylindrical; a tapered portion adjoining said body portion, said tapered portion tapering to form a shoulder on said implant between said proximal end and said distal end; a distal portion adjoining said tapered portion and extending along said longitudinal axis at said distal end of said implant, said distal portion tapering such that a cross section of said distal portion becomes smaller toward said distal end; said implant having an opening in said distal portion extending through said implant in a direction transverse to said longitudinal axis; wherein a radial dimension of said multi-angular portion at a point between said ridges is substantially the same as a radial dimension of said body portion to provide a substantially smooth interface between said multi-angular portion and said body portion at said point to facilitate insertion of said multi-angular portion within said receptor bone; wherein a radial dimension of said multi-angular portion at said ridges is greater than said radial dimension of said body portion to allow said multi-angular portion to form an interference fit between said implant and said receptor bone; wherein said body portion has a substantially smooth surface, characterized by an absence of threads; wherein said implant is solid characterized by the absence of a cannulation along said longitudinal axis; wherein said implant is made of metal; wherein said polygonal cross section is substantially square; wherein said tapered portion has a length that is less than one fourth a length of said distal portion; wherein said multi-angular portion has a fitting disposed thereon for attaching a driving member; and wherein said implant is configured to receive a strand in said opening to position said replacement ligament against said implant for securing said replacement ligament in said bone tunnel. 